Mindfulness

Mindfulness is the awareness that emerges

from “paying attention in a particular way:

on purpose, in the present moment and non

judgmentally”

Jon Kabat Zinn, 1990 & Zindel Segal

Mindfulness Based Cognitive Therapy

(MBCT) for Depressive Relapse

Mindfulness Based Stress Reduction

(MBSR)

History of Mindfulness

Teachings of the Buddha (5th

Century BC)

Buddhist Canons

Passed on orally for 450 yrs

Theravada

Vajrayana Mahayana

Chan, Zen, Son, Pure Land, Nichiren, Tendai,

Shingon, etc

China, Japan, Vietnam, Korea, etc

Vipassana

Western Schools of Traditional Buddhism

Tantric, Gelug, Nyingma, Kagyu, Sakya, etc

Sri Lanka, Thailand, Laos, Cambodia, Myanmar,

India, etc

Tibet, Mongolia, Nepal, India, Bhutan,

Russia, etc

Secular Buddhism

“Therapeutic” Mindfulness (MBSR,

MBCT)

The West

Buddhist Psychology

Personal Mindfulness Practice

MBCT and MBSR training require significant personal mindfulness practice as a prerequisite

before training to become a mindfulness teacher. This includes at least one year of personal

daily meditation practice and attendance of an 8 week mindfulness course.

The message here is that mindfulness is best taught from a place of embodied knowledge

through personal practice and application.

Treatment modality

Mode of enhancing therapeutic

relationships

Mode of Self Care

Personal Mindfulness Practice

Mindfulness in Healthcare

Research on Mindfulness Based Interventions

Depression • MBCT protects against relapse/recurrence of depression on par with antidepressants (n=160)

• Segal, V.Z et al, Archives of General Psychiatry 2010;67(12):1256-1264

• Mindfulness-based therapies (MBSR/ MBCT) effective for mood/anxiety/cancer related mood disturbance in a meta-analysis of 39 studies.

• Hoffman, S.G. et al, Journal of Consulting and Clinical Psychology, 2010; 78(2):169-183

Stress • MBSR decreases stress and improves both physical & mental health indices - meta-analysis of 20 studies.

• Grossman, P. et al., Journal of Psychosomatic Research, 2004; 57(1):35-43

• Canadian Institute of Stress: programs reduce absences by 18%, grievances by 32%, disability time by 52%, increase productivity by 7% and service quality by 13%.

• Fries M, Journal of Academic and Business Ethics, 2003,Vol 2

Meta-Analyses • Khoury et al, Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev (2013)

• Moderate effect sizes in pre-post and waitlist control studies in depression, anxiety and stress

• Low effect sizes in active control studies

• Goyal M, et al Meditation programs for psychological stress and well-being: a systematic review & meta-analysis. JAMA Int Med (2014)

• Moderate effect for mindfulness meditation in depression, anxiety and pain

• Low or no evidence for stress, quality of life and other outcomes

• No superiority to other established treatments like CBT

• No effect for mantra based meditation

• Strauss C, et al Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLoS One 9(4) 2014

• Medium effect for depressive symptoms

• Non significant effect for anxiety symptoms

• MBCT had greater effect than MBSR

• Less effect when compared to active controls

Mechanisms of Mindfulness

Intentions Attitudes Attention

• To attend to present moment experience, even if it is difficult

• Not to fix or achieve any special state of relaxation, transcendence or transformation

• To develop a different relationship to experience vs engaging in cognitive elaboration about experience

• Beginner’s Mind

• Patience

• Trust

• Non-Striving

• Compassion

• Non-Judgment

• Curiosity

• Acceptance

• Establishing, holding and shifting attention using the body - the senses (Taste, Smell, Sound, Sight, Touch) and awareness of sensations

• Focus & Concentration (focus on the breath - interoception)

• Open monitoring/receptive awareness to thoughts, emotions, body (sound, sensations)

Skills & Shifts

• Increased attention regulation

• Increased emotion regulation

• Increased tolerance for difficult mood states and distress

• Decreased negative self/other-evaluations

• Equanimity (suspension of judging experience as intrinsically good or bad)

• Increased empathy & compassion

• Moving from behavioral reactivity to skillful

• Decreased avoidance

• Decreased mental proliferation (rumination & worry)

• Quicker recovery from reactivity

response

Unpleasant Experiences Commonly Encountered in Practice

Unpleasant Experience Mindful Response Wandering Attention Notice the wandering of attention and then kindly return

attention to the focus. It is also often helpful to hold an intention to be curious about whatever is pulling the attention without engaging in the content.

Sleepiness Become interested in sleepiness – investigate how the body feels, notice changes in awareness and thinking. Some concrete strategies include opening the eyes, adopting an erect posture, or standing up.

Boredom Curiosity can be thought of as an antidote. Begin with investigating boredom itself with some curiosity – how do you know you’re bored?

Physical Pain Drawing your attention into the physical experience of pain and knowing the difference between thinking about pain and the sensation of pain itself. Take care of the body by adopting a comfortable posture and adjusting as needed.

Restlessness Movement practices can often be a good place to start when there is a lot of restlessness. Also it can be very helpful to be welcoming of restlessness if possible by investigating the physical feelings with some curiosity.

Doubt Aspects of doubt can be useful. An element of doubt is the uncertainty of what lies in the future. In practice this usually means “will this be helpful?” or “what is the point of this?” A good strategy here is to welcome the uncertainty (because it is a fundamental aspect of being alive)

Desire Wanting things to be other than they are is part of the human condition. When this happens in practice we get the opportunity to respond differently to craving by exploring what is present without fixing or changing it.

Thought Fusion (Believing your thoughts)

Observing thoughts as thoughts rather than believing them as facts is an important part of practice. The mind is a thought producing factory and often those thoughts are not exactly based in reality or the only way to think about experience.

Mindfulness Reminders

• Dots, stickers

• Magnet

• Apps

• Post-its

• Friend/relative

• Community

• E-Newsletter

• Morning intention

• Gratitude Journal

• To Be List beside To Do List

• Alarm reminders

• Workplace practice (sitting groups, yoga classes, daily

walks)

• Mindfulness buddy

• Everyday mindfulness (walking, eating, 3MBS)

• Regular meditation group

Raisin Exercise

Key Points about the Exercise

The raisin exercise is accessible and requires no meditation experience It can be easier for some to focus on an external object using all of the senses rather than using

a focus on the breath or body. Introduces an informal mindfulness practice – mindful eating. Utilizes and brings attention to many sensations which is a way to begin working with the body. Allows participants to have a direct experience of present moment sensation. Provides a shared experience to discuss key mindfulness principles.

The training of attention – Bring attention to an object, hold attention on an object, release attention of the object, re-establish attention elsewhere.

Bringing curiosity to experience. Noticing mind wandering. Past and future oriented thinking. Associations and memories. Contingent emotions and physical sensations.

Relevance of the Exercise

The mind tends to move quickly into the past or future and so bringing awareness to this kind of

mental proliferation can help to disrupt it. Training the attention can help to disrupt cognitive elaboration by:

Becoming aware by bringing it to consciousness and out of automaticity. Deliberately releasing attention from these thought processes and establishing

awareness elsewhere.

Body sensations provide an anchor to the present moment. These sensations can be a place to bring one’s attention as a way of disrupting habitual modes of thinking. By changing the way we pay attention to eating this raisin we have a different experience from the usual experience of eating. This serves as a parallel process to begin to relate differently to difficult emotions such as sadness, guilt, worry and anxiety.

Body Scan

Key Points about the Practice

Trains the ability to establish, hold, and shift attention.

Shifts from a mode of “doing” to a mode of “being”.

The purpose isn’t to change anything but simply to notice what is present.

Relaxation is not the goal.

Emphasizes the importance of noticing when one’s attention has wandered off from the focus of

the bodyscan, and then returning attention back to a focus on the body.

This action of noticing and returning is just as important as staying focused.

Systematically moves the attention around the body.

Allows the observation that a wandering of attention is the norm.

A longer meditation allows participants to have a full range of experience; to notice the tendency

to judge, react, compare, and strive.

This practice allows people to have a variety of bodily sensations, pleasant and unpleasant, that

they may or may not associate with emotion and/or memories.

The intended outcome is awareness. It is not to achieve a special state.

Relevance of the Exercise

People coping with depression often have a lack of sensorial experience and so the bodyscan

begins to increase the capacity to notice bodily sensations.

Increases the threshold for tolerating sensation, often low in people coping with anxiety or high

stress.

Having the experience of noticing sensations and emotional states come and go in the

bodyscan provides the experiential insight that everything comes and goes including physical

pain (changes in severity if chronic) and distressing emotional states.

By noticing anxiety, stressful states and depression for what they are – a set of experiences

comprised of thoughts, emotions, body sensations and behaviours or impulses to act –

participants can begin to defuse from their stories and see these experiences for what they are.

(I am not my depression or anxiety or stress).

Begins to highlight that wandering attention can be potentially dangerous for mood.

Begins the process of experiencing the sensorial correlates of emotions.

Begins the process of learning to use the body as an alternate place to attend during difficult

states.

Awareness of Breathing

Key Points about the Practice

• Provides an internal, moving focus for attention.

• Trains the attention to a single focus of concentration over an extended period.

• Develops the body (breath) as a place to return to when one wakes up to wandering attention.

• Develops the breath as a refuge – a place to return over and over again.

• Brings awareness to the changing nature of internal and external experience.

• Reinforces the norm of wandering attention.

• Reinforces the arising and passing of all experience.

• Allows for the witnessing of experiences comprised of thoughts, emotions, behaviours and

bodily sensations from a point of reference (the sensations of breathing).

Relevance of the Exercise

Increases awareness of what happens to the body when one is anxious (e.g. the breath

becomes shallow).

Continues the process of experiencing the sensorial correlates of emotions; bringing attention to

areas of the body where difficult states often show up.

Begins the process of using the body as a refuge and a place from which to witness difficult

experience – decentering.

Helps to prevent the attention from being hijacked into negative spirals of thought or emotions.

Helps to defuse from emotion and to see emotions as sensations.

Allows for turning toward the difficult vs. experiential avoidance or problem solving through the

parallel process of attending to challenging sensations when they arise.

Continues to train the attention by enhancing the ability to focus on an object, noticing when that

focus is lost, and returning attention to a chosen object of awareness. These skills are relevant

because they provide:

o the opportunity to notice when one’s attention is stuck in rumination or worry.

o the ability to redirect one’s attention to the breath which can disrupt cascading negative

thoughts.

o the skill of bringing attention to the body sensations of breathing which provides another

way to experience difficult emotions or experiences (rather than thinking about them).

Breathing Space

Key Points about the Practice

Checking in to present experience.

The structure of this practice is essential.

It takes the shape of an hour glass by starting with a wide view of all thoughts, emotions, and bodily sensations (the top wide part of the hourglass), then narrowing in to a focus on the sensations of breathing in the lower abdomen (the neck of the hourglass), and then expanding back out again to the entire body (the open bottom of the hourglass).

The 3 minute breathing space encompasses a number of awareness practices.

Holding a wide and open awareness in step 1.

Focused concentration in step 2.

A form of choice-less awareness of body sensations in step 3.

Moving attention from one object of awareness to another (the holding and releasing of attention).

It is important to note that this is actually quite a difficult practice and can take time for people to understand what it is they are doing in each step.

Provides practice in coming quickly into a formal practice.

Quick parsing of experience: thoughts, emotions, bodily sensations.

Moving from step 1 to step 2 allows for a shift from a focus on cognitive/emotional awareness to focused concentration on the body.

This is a practice that can be generalized to everyday life, providing a way to pause.

Relevance of the Practice

Intentional shift of focus to the belly becomes useful for dealing with distress because bringing attention to the sensations of breathing can interrupt the cascading of thoughts.

Provides frequent practice in disengaging from habitual patterns of mind (vulnerable to negative moods); a way to check in with present experience.

This practice is a bridge between formal and informal practice. It helps to bring a more mindful approach to the moments of the day. This is the reason for scheduling it three times a day as a home practice.

This practice is NOT about fixing or changing anything. This comes up often and it is important to notice if participants are using it in this way. The purpose is simply to notice what is present now.

Movement Practice (Yoga/Walking)

About the Exercise

The focus of the practice is to bring awareness to sensations in the body arising through

movement and in different postures, letting go of thoughts about the sensations.

We are not concerned about getting poses “right” (but ensure there are no injuries).

Body is an anchor to the present.

Attention to sensations may change the sensations themselves.

As in the body scan, breathing, and in the raisin exercise, we are working with bringing attention

to a focus, holding attention there, noticing when it wanders off, and re-establishing focus when

needed.

For some (often people with a lot of anxiety), incorporating movement can initially be an easier

focus than breath. Movement may reduce agitation.

Bringing awareness to simple movements can be a way of bringing mindfulness into daily life.

Walking to work is an example.

Relevance of the Exercise

A movement practice can help one notice how attention can be hijacked by thinking.

The movement practice is relevant in many of the same ways as the breathing meditation or the

bodyscan because we continue to work with attention.

The addition of movement can help illustrate some key points in a different way.

The tendency to strive to achieve a certain posture.

Noticing our ideas about what we can or cannot do – “I can’t do yoga” or “I’m not flexible”

– and how this thinking influences behavior and affect.

The practice may provide the opportunity for an unexpected outcome to emerge.

Noticing judgment about how well we are doing in a certain posture.

Noticing comparative thinking as it comes up when noticing how other participants are

doing the poses.

The movement practice is body-based which further develops the body as a different focus

through which to experience life.